title: Risk of suicide is insufficient warrant for coercive treatment for mental illness.
abstract: Mental health laws in many jurisdictions currently permit coercive treatment for persons with mental illness who are thought to be at risk of harm to themselves or others. These laws are often used to provide involuntary treatment to persons who are thought to be at risk of suicide. In this article we argue that legislated coercive psychiatric treatment should not be triggered by an assessment of the likelihood of harm, including a likelihood of suicide, but should be available only where a person is found to lack capacity to make their own decisions about their own health risks, after appropriate support has been given. We suggest that current opposition to this approach may find its origin in factors including uncertainties about the idea of vulnerability and its relationship to capacity as well as tendency to minimise the real costs of psychiatric treatment and coercion against the aim of suicide prevention. Given the limits of suicide risk assessment, we argue that a public policy that allows involuntary preventative detention of competent persons thought to be at risk of suicide, places too great a burden on all persons living with mental illness to be justified. We suggest that we are better placed to serve the interests and respect the human rights of people with mental illness if we respect and support the right of persons to make decisions, rather than focussing on perceived vulnerabilities and calculations of suicide risk.
authors.affiliation: Centre for Values, Ethics and the Law in Medicine, University of Sydney, Australia. Electronic address: sascha.callaghan@sydney.edu.au.
authors.forename: Sascha
authors.initials: S
authors.lastname: Callaghan
authors.forename: Christopher
authors.initials: C
authors.lastname: Ryan
authors.forename: Ian
authors.initials: I
authors.lastname: Kerridge
mesh_terms: D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000331:legislation & jurisprudence*; D026684:Personal Autonomy; D018570:Risk Assessment; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention
keywords: Human rights; Involuntary treatment; Risk assessment; Suicide